Provider Demographics
NPI:1750568192
Name:WEBER, DAVID E (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:WEBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11661 PRESTON RD
Mailing Address - Street 2:STE 145
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2745
Mailing Address - Country:US
Mailing Address - Phone:214-368-8825
Mailing Address - Fax:214-368-8823
Practice Address - Street 1:11661 PRESTON RD
Practice Address - Street 2:STE 145
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2745
Practice Address - Country:US
Practice Address - Phone:214-368-8825
Practice Address - Fax:214-368-8823
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3403T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112388703Medicaid
TX112388703Medicaid
TXT16583Medicare UPIN